The Use of STRATAFIX Suture Device Compared to Standard-of-care for Deep Tissue Closure in Total Knee Arthroplasty

Overview

The STRATAFIX (Ethicon, Johnson and Johnson, Somerville, New Jersey) Knotless Tissue Control suture device is a barbed suture that uses anchor technology to securely engage with the soft tissues while also eliminating the need for knots. The anchors, or barbs, are pressed out of the device core or formed within the core in a geometric pattern and arranged in a tapered manner to allow the device to pass through tissue in the direction toward the needle during closure. These knotless tissue control devices are deployed using a continuous technique, which is anticipated to be faster and more cost-effective than interrupted suturing.

Preclinical and biomechanical studies have demonstrated efficacy in cosmetic skin and deep tissue closures.\[1\], \[2\] In addition, barbed sutures have been shown to provide water-tight closure and wound strength comparable to or superior to closure with conventional sutures. Many comparative studies have been published contrasting barbed sutures to conventional closure techniques in multiple surgical fields. \[3\], \[4\] Various studies have evaluated the outcomes of different barbed suture devices, however there are no reports assessing the length of closure times using STRATAFIX (Ethicon, Johnson and Johnson, Somerville, New Jersey) Knotless Tissue Control Devices during deep closure in total hip arthroplasty. Stephens et al. \[5\] performed a prospective randomized study of 500 total knee arthroplasty patients who received either barbed suture (250) or conventional sutures (250) for deep closure of the surgical wound. The mean operating time was significantly shorter in the barbed group as compared to conventional group (64.3 vs 68.1 minutes, p=\<0.001). In a study of 80 TKA (61 barbed, 19 conventional deep sutures) and 54 THA patients (37 barbed, 17 conventional deep sutures), Smith et al. \[6\] found significantly shorter closure time in the barbed suture group (16.78 vs. 26.5 minutes, p\<0.001). One study reports one the use of Stratfix suture for intracorporeal suturing in myomectomy. Giampaolino et al. \[7\] performed a prospective randomized study on 47 patients and evaluated the mean operative time for laparoscopic posterior myomectomy using Stratafix or conventional suture for intracorporeal suturing. There was a significant decrease in mean operative time associated with use of Stratafix suture as compared to conventional suture (66.3 vs 73 minutes, p=0.005). This prospective randomized single-center study will examine the outcomes, mainly closure time, of deep closure during total knee arthroplasty using the STRATAFIX Symmetric PDS Plus (Ethicon, Johnson and Johnson, Somerville, New Jersey) barbed suture compared to interrupted VICRYL suture (Ethicon, Johnson and Johnson, Somerville, New Jersey).